The correlation of inflammatory and metabolic markers with cognitive impairment in patients with cerebral small vascular disease

doi:10.11817/j.issn.1673-9248.2022.01.007

Abstract

Abstract:

Objective

To explore the correlation of inflammatory and metabolic markers with cognitive impairment in patients with cerebral small vascular disease (CSVD), and to establish an early prediction model.

Methods

120 cases of CSVD patients admitted to Department of Neurology in our hospital from September 2020 to September 2021 were included. According to Montreal cognitive assessment (MoCA) score, they were divided into Non-cognitive impairment (NCI) group of 45 cases and Cognitive impairment (CI) group of 75 cases. Inflammatory biomarkers of patients in the two groups were compared, including hypersensitive C-reactive protein (hs-CRP), lipoprotein phospholipase A2 (Lp-PLA2), interleukin 6 (IL-6), total bilirubin (TBIL), and metabolic biochemical indexes including homocysteine (Hcy), cystatin C (Cys-C), glycosylated hemoglobin (GHb), and low density lipoprotein cholesterin (LDL-C). Univariate and logistic multifactor regression analyses were conducted, and prediction models were established to analyze the correlation and diagnostic value of each index with cognitive impairment in CSVD patients.

Results

The expression levels of serum LP-PLA2, IL-6, Hcy and Cys-C in CI group were significantly higher than those in NCI group [(124.03±55.00) ng/ml vs (58.58±39.66) ng/ml; (2.26±0.89) pg/ml vs (1.10±0.48) pg/ml; (31.07±11.63) μmol/L vs (14.81±7.40) μmol/L; (1.04±0.34) ng/L vs (0.76±0.20) ng/L], and the expression levels of serum TBIL were significantly lower than those in NCI group[ (15.45±3.74) μmol/L vs (18.97±4.68) μmol/L], the differences were statistically significant (t=6.965, 8.075, 8.403, 5.121,-4.536; all P＜0.001). Multivariate logistic regression analysis of the 5 indexes showed that the increased levels of serum Lp-PLA2, IL-6, Hcy and Cys-C were independent risk factors of cognitive dysfunction in CSVD patients (OR=1.017, P=0.029; OR=2.117, P=0.004; OR=1.155, P=0.003; OR=2.901, P=0.002). Receiver operating characteristic (ROC) curve of serum LP-PLA2, IL-6, Hcy, Cys-C and the combination of the four indexes for the diagnosis of secondary cognitive impairment in patients with CSVD was plotted, and the areas under the curve (AUC) values were 0.883, 0.886, 0.905, 0.803 and 0.951, respectively.

Conclusion

The expressions of inflammatory markers Lp-PLA2 and IL-6 and metabolic markers Cys-C and Hcy are correlated with the cognitive impairment of CSVD patients to a certain extent, suggesting the early diagnosis of cognitive impairment in CSVD patients. The combined detection of the two markers is helpful for the early detection of cognitive impairment in CSVD patients and clinical intervention to avoid further progression to vascular dementia.

Key words: Cerebral small vessel disease (CSVD), Cognitive impairment, Inflammatory markers, Metabolic markers

Linrui Qi, Rong Zeng, Fengyun Hu. The correlation of inflammatory and metabolic markers with cognitive impairment in patients with cerebral small vascular disease[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(01): 32-37.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.11817/j.issn.1673-9248.2022.01.007

https://zhnxgbzz.cma-cmc.com.cn/EN/Y2022/V16/I01/32

Figures/Tables 5

组别	例数	女性[例（%）]	年龄（年， $x ¯$ ±s）	受教育年限（年， $x ¯$ ±s）	高血压[例（%）]	吸烟史（超过15年）[例（%）]	饮酒史（超过5年）[例（%）]
认知障碍组	75	33（44.00）	62.38±8.04	5.25±3.11	46（61.33）	52（69.33）	15（20.00）
无认知障碍组	45	25（55.56）	64.19±8.23	5.29±3.47	20（44.44）	26（57.78）	11（24.44）
统计值		χ²=1.504	t=1.183	t=0.065	χ²=3.241	χ²=1.651	χ²=0.327
P值		0.220	0.239	0.958	0.072	0.199	0.567

组别	例数	女性[例（%）]	年龄（年， $x ¯$ ±s）	受教育年限（年， $x ¯$ ±s）	高血压[例（%）]	吸烟史（超过15年）[例（%）]	饮酒史（超过5年）[例（%）]
认知障碍组	75	33（44.00）	62.38±8.04	5.25±3.11	46（61.33）	52（69.33）	15（20.00）
无认知障碍组	45	25（55.56）	64.19±8.23	5.29±3.47	20（44.44）	26（57.78）	11（24.44）
统计值		χ²=1.504	t=1.183	t=0.065	χ²=3.241	χ²=1.651	χ²=0.327
P值		0.220	0.239	0.958	0.072	0.199	0.567

组别	例数	hs-CRP（ng/L）	Lp-PLA2（ng/ml）	IL-6（pg/ml）	TBIL（μmol/L）	GHb（%）	Hcy（μmol/L）	CysC（ng/L）	LDL-C（mmol/L）
认知障碍组	75	1.058±0.50	124.03±55.00	2.26±0.89	15.45±3.74	5.7±1.2	31.07±11.63	1.04±0.34	2.99±0.55
无认知障碍组	45	1.118±0.58	58.58±39.66	1.10±0.48	18.97±4.68	5.5±1.1	14.81±7.40	0.76±0.20	3.09±0.71
t值		0.696	6.965	8.075	-4.536	0.911	8.403	5.121	0.864
P值		0.488	＜0.001	＜0.001	＜0.001	0.364	＜0.001	＜0.001	0.390

指标	B值	SE值	Wals值	P值	OR值	95%可信区间
Hcy	0.144	0.048	9.070	0.003	1.155	1.052~1.268
CysC	7.293	2.408	9.172	0.002	2.901	0.846~6.991
TBIL	-0.070	0.096	0.531	0.466	0.973	0.772~1.126
IL-6	2.144	0.740	8.399	0.004	2.117	1.027~5.500
Lp-PLA2	0.017	0.008	4.747	0.029	1.017	1.002~1.032

指标	Cutoff值	敏感度（%）	特异度（%）	Youden值	AUC值	95%可信区间
Hcy	16.600	96.0	75.6	0.716	0.905	0.846~0.965
CysC	0.755	89.3	57.8	0.471	0.803	0.719~0.886
IL-6	1.655	76.0	86.7	0.627	0.886	0.829~0.943
Lp-PLA2	81.900	77.3	88.9	0.662	0.883	0.817~0.949
联合检测		92.0	82.2	0.742	0.951	0.918~0.984

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